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Interpretation Bias in Anxious Mothers and Their Children

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Interpretation Bias in Anxious Mothers and Their Children Interpretation Bias in Anxious Mothers and Their Children: Can Interpretation Modification Affect the Intergenerational Transmission of Anxiety? Kristy E. Benoit Dissertation submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy In Psychology Thomas H. Ollendick, Chair George A. Clum Martha A. Bell Jungmeen E. Kim-Spoon Danny Axsom March 4th, 2013 Blacksburg, VA Keywords: Interpretation Modification, Anxiety, Mother, Child Copyright 2013, Kristy E. Benoit Interpretation Bias in Anxious Mothers and Their Children: Can Interpretation Modification Affect the Intergenerational Transmission of Anxiety? Kristy E. Benoit Abstract A currently burgeoning area of research has demonstrated that interpretation biases play a causal role in the onset of anxiety, and by training interpretation biases towards benign interpretations of ambiguity, experimental paradigms can be used to decrease levels of clinical and trait anxiety in both adults and children. Drawing on this well-documented experimental literature, and recently growing treatment literature, training anxious mothers to more benign interpretations of ambiguity in their children‟s environment may not only lessen their own anxious cognitions, but also reduce the anxious cognitions they transmit to their children. The primary objective of the current study was to determine whether a uniquely interpersonal interpretation modification paradigm (IMP) could alter the transmission of an anxious information processing style from clinically anxious mothers to their children. Results suggest that the IMP, compared to a control condition, resulted in fewer child-referent anxious cognitions in mothers and warmer maternal behavior directed to children during preparation for an anxiety- provoking speech task; however, child self-referent anxious cognitions, child behavior, and child physiological arousal during the speech task were not differentially affected. Mother and child general interpretation biases decreased over time in both groups. The current study is discussed as a pivotal step towards assessing the feasibility of modifying anxious mothers‟ interpretation biases concerning their children in real-life clinical settings. Acknowledgements I would like to thank a number of individuals for their encouragement and support throughout this research project. First, I wish to thank my supervisors. In particular, I extend my gratitude to my advisor, Thomas Ollendick, for his boundless enthusiasm, unwavering commitment to my professional development, and willingness to serve as a true guide and mentor. I am also thankful to my additional committee members, George Clum, Martha Ann Bell, Jungmeen Kim-Spoon, and Danny Axsom, for their insightful suggestions and supportive comments throughout this process. Also deserving of recognition is Cathy Creswell, who has been a wonderful consultant on this project, promptly answering the many, many questions I sent her way. Second, I would like to thank the many undergraduate and graduate research assistants who helped to make this project possible. Sarah Terrell, Christian Putnam, Jennifer Nguyen, Danielle Gilchrist, Chantie Nguyen, Caitlin Sedlar, and Cynthia Fiorino were integral to much of the “beyond-the-scenes” work. Also assisting with assessments and coding were Amie Schry, Kate Donlon, Thorhildur Halldorsdottir, and Kaushal Amatya. Finally, Kristin Austin has done a wonderful job of directing the project in my absence. I am grateful to them all. Finally, I want to thank my close friends and family for their encouragement and support of this PhD pursuit. I could not have made it this far without you cheering me along every step of the way. iii Table of Contents Abstract ii Acknowledgements iii Table of Contents iv List of Figures vi List of Tables vii Introduction 1 1.1 Overview of Anxiety Disorders in Children and Mothers 1 1.2 Interpretation Bias in Anxious Mothers and Children 3 1.3 Theory of Intergenerational Transmission of Anxious Cognitions 7 1.4 Experimental Evidence for the Intergenerational Transmission of 10 Anxious Cognitions 1.5 Interpretation Modification 12 1.6 Potential Moderators of the Transmission of Anxious Cognitions 16 1.7 Current Study 17 2. Method 20 2.1 Participants 20 2.2 Recruitment 25 2.3 Research Design 25 2.4 Materials 26 2.4.1 Interpretation Modification Program (IMP) and Interpretation 26 Control Condition (ICC) 2.4.2 Recognition Test 29 2.4.3 Booster Training 30 2.5 Procedure 31 2.6 Experimental Task 33 2.7 Measures 35 2.7.1. Measure of Clinical Status 35 2.7.1.1 Anxiety Disorders Interview Schedule for 35 DSM-IV Lifetime 2.7.1.2 Anxiety Disorders Interview Schedule, Child 36 and Parent Version 2.7.2 Measures of Maternal Anxiety 37 2.7.2.1 State-Trait Anxiety Inventory 37 2.7.2.2 Anxiety Sensitivity Index 37 2.7.3 Measures of Child Anxiety 37 2.7.3.1 Spence Children‟s Anxiety Scale - Child and 38 iv Parent Report Versions 2.7.3.2 Fear Survey Schedule for Children - Revised 38 2.7.3.3 Childhood Anxiety Sensitivity Index 39 2.7.4 Measures of General Interpretation Bias 39 2.7.4.1 Ambiguous Scenarios Questionnaire - Child 39 2.7.4.2 Ambiguous Scenarios Questionnaire - Parent Child 40 2.7.5 Measures of Specific Interpretation Bias 41 2.7.5.1 Predicted Distress, Coping, and Performance 41 Scale - Child 2.7.5.2 Predicted Distress, Coping, and Performance 42 Scale - Parent Child 2.7.6 Measures of Maternal Behavior 42 2.7.7 Measures of Child Behavior 44 2.7.7.1 Actual Distress, Coping, and Performance Scale - 44 Child 2.7.7.2 Actual Distress, Coping, and Performance Scale - 44 Parent Child 2.7.7.3 Behavioral Observation of Children 45 2.7.8 Apparatus 46 2.7.8.1 IMP/ICC 46 2.7.8.2 Physiological Equipment 46 3. Results 46 3.1 Data Analytic Plan 46 3.2 Demographic, Diagnostic, and Questionnaire Data 47 3.3 Effectiveness of IMP 47 3.4 Effect of Training on Mothers Specific Interpretation Bias 49 3.5 Effects of Training on Maternal Behavior during the Discussion Task 50 3.6 Effects of Training on Child Behavior during the Discussion Task 50 3.7 Effects of Discussion Task on Child Specific Interpretation Bias 51 3.8 Effects of Training on Child Behavior during the Speech Task 51 3.9 Effects of Training on Child Physiology during the Speech Task 52 3.10 Effect of Training on General Interpretation Bias in 52 Mothers and Children 3.11 Exploratory Analyses 53 4. Discussion 55 5. References 62 v List of Figures Figure 1. Mean Reaction Time to Positive and Negative Probes for the Control 86 and Experimental Groups Figure 2. Mean Recognition Ratings for the Control and Experimental Groups 87 Figure 3. Change in Mothers Specific Interpretation Biases from Pre- to 88 Post-Training for Control and Experimental Groups Figure 4: Change in Mothers General Interpretation Bias from Session 1 to Session 89 2 for Control and Experimental Groups vi List of Tables Table 1. DSM-IV Anxiety Disorder Diagnoses in Mothers 76 Table 2. DSM-IV Anxiety Disorder Diagnoses in Children 77 Table 3. Socio-demographic Information for the Control and Experimental Groups 78 Table 4. Diagnostic and Questionnaire Information for Control and 79 Experimental Groups Table 5. Reaction Time Data for Control and Experimental Groups 80 Table 6. Interpretation Ratings for Control and Experimental Groups 81 Table 7. Change in Mothers Specific Interpretation Biases from Pre- to Post-Training 82 for Control and Experimental Groups Table 8. Maternal Behavior during the Discussion Task for Control and 83 Experimental Groups Table 9. General Interpretation Biases in Mothers and Children for Control and 84 Experimental Groups Table 10: Correlations between Strength of Training and Maternal Cognition and 85 Behavior vii Introduction Overview of Anxiety Disorders in Children and Mothers Anxiety disorders are among the most common psychological difficulties occurring in childhood. While fear and anxiety is most often a normal response to environmental threat that entails obvious evolutionary benefits, it becomes excessive, maladaptive, and significantly interfering for children with anxiety disorders. A review of the epidemiological literature reveals prevalence rates for children up to and including 11 years of age ranging from 2.6% to 41.2% (Cartwright-Hatton, McNicol, & Doubleday, 2006). Differences are likely due to the presence of very young children, the varying types of prevalence explored, and the different settings investigated. It appears that most studies yield child and adolescent prevalence rates of between 8 and 12% (Bernstein & Borchardt, 1991; Costello & Angold, 1995: Dadds, Spence, Holland, Barrett, & Laurens, 1997). Such rates make anxiety disorders more common than depressive disorders and likely more prevalent than disruptive behavior disorders as well (Cartwright- Hatton et al.) Epidemiological studies with adults show similar results: anxiety disorders have the earliest age of onset distributions, with a median age of onset of 11 years of age (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). Child anxiety („child‟ will refer to „child and adolescent‟ throughout) most commonly falls into one of nine categories; however, there are four main diagnostic categories (American Psychological Association, 2000). Children with separation anxiety disorder (SAD) experience intense fear upon separation from caregivers and often worry that harm will befall themselves and/or their caregivers during periods of separation. Social phobia (SP) is marked
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